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Nursing Homes Urged to Stand Pat as States Move to Expand Visits

Feb. 12, 2021, 7:12 PM

State lawmakers’ efforts to relax visitation limits at nursing homes, as Covid-19 cases fall and vaccinations rise, are prompting concerns that changing the protocol too soon could cause infections to spike.

New York, Indiana, and Georgia are moving to ease restrictions as more facilities complete their second round of Covid-19 vaccinations. But a top federal health official says it’s too soon to let up—shining a light on the tension between the need to keep vulnerable residents safe and the emotional toll a long quarantine-like situation exacts on them and their families.

“We cannot change our visitation or other guidance now at this moment in time, but we are looking at it and want to change it as soon as possible,” Evan Shulman, director of the division of nursing homes at the Centers for Medicare & Medicaid Services, told nursing home operators Thursday. “Until then, everyone needs to keep doing what you’re doing.”

Shulman warned that it’s not the time to dial back federal guidance that only allows indoor visits at facilities with no new Covid-19 infections in the last two weeks, and bars them altogether in counties with infection rates above 10%.

The legislative push by states to resume standard visitations reflects two key developments: Covid-19 infections and virus-related emergency room visits are trending downward across the country, and nearly 1.4 million people in nursing homes and other long-term care facilities have completed their two-dose vaccine regimen. Another four million have received the first shot.

That progress has created an opening for state lawmakers eager to allow “essential care partners,” like close family members and friends, to visit residents under strict safety protocols.

But Shulman said that could be problematic. “If everyone in the facility has an essential caregiver and they’re all visiting at the same time, that could cause some infection prevention and control concerns, that we would all be very concerned about,” he said in a Thursday call sponsored by LeadingAge.

Nearly 147,000 residents at nursing homes and other long-term care facilities have died from Covid-19 as of Feb. 11, according to the Kaiser Family Foundation. That’s about 37% of all U.S. Covid-19 deaths.

States Look to Open Doors

Earlier this week, the New York Senate Health Committee advanced a bill (S.B. S614A) that directs the state health department to craft rules authorizing resident visits under special circumstances, even though general visitation remains restricted due to the pandemic.

“For many residents it has become a life or death issue. My bill creates the opportunity to reopen visitation while ensuring top safety standards, so that family members can be reunited and residents can get the care and attention they need,” said New York State Sen. Rachel May (D), the bill’s sponsor.

In Indiana, a similar bill (S.B. 202) is headed to a full Senate vote after unanimously passing out of committee last week. And on Feb. 10 in Georgia, the legislative committee started deliberating H.B. 290 ,which would bar nursing homes from obtaining or renewing an operating license if they stopped patient visits amid a “declared public health emergency.”

“No one should be required to live or die in isolation from their loved ones!,” the bill’s sponsor, Georgia Rep. Ed Setzler (R) said in a tweet.

Variants Cause Uncertainty

Shulman said loosening federal restrictions now would be a mistake since it’s unclear how the vaccine will hold up against more contagious Covid variants.

In addition, “We don’t know if the vaccine prevents transmission,” he said.

While both Covid vaccines have shown to prevent severe symptoms, “it is plausible” that a resident who has been fully vaccinated could become infected by a visitor and “that resident may not get sick, but could potentially transmit the virus to someone else in the facility. And that is a big risk,” Shulman said.

The American Health Care Association, which represents more than 14,000 U.S. nursing homes, is urging the federal government to update its visitation guidance to avoid “confusing or inconsistent” state practices.

The group is also asking the Centers for Disease Control and Prevention for additional research on the vaccine’s effectiveness among nursing home residents. Shulman said it’s unclear when that would come.

“The short answer is ‘not yet.’ Not sure exactly when. But we want to do it as soon as possible,” he said.

An independent nursing home commission report said in September that in-person visitation is a “vital resident right” and called for “consolidated, evidence-based guidance on safely increasing controlled, in-person visitation.”

To contact the reporter on this story: Tony Pugh in Washington at tpugh@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Alexis Kramer at akramer@bloomberglaw.com